Systematic Desensitization of Hyperacusis and Vocal Pitch Disorder Treatment in a Patient with Autism

Background: Hyperacusis is the difference in dB between a normal threshold of audibility for a stimulus and the dB level at which that stimulus becomes intolerably loud. Some persons with autism exhibit symptoms of hyperacusis possibly attributable to phobias to auditory stimuli. Desensitization procedures have been used as a treatment for phobias and appear a promising treatment for patients with autism and hyperacusis. Methods: Our participant was a 26 year old male previously diagnosed Asperger\u27s syndrome who presented with hyperacusis to low-pitched voices and a concomitant vocal disorder manifesting mainly as high vocal pitch. Despite not fully accepting treatment goals he agreed to treatment in our clinic. A systematic auditory desensitization program was employed to treat hyperacusis, including use of recorded male voices, musical instruments, and environmental sounds. In addition, a modified vocal re-education therapy program was also employed which included instruction on easy onset of phonation, biofeedback, ergonomic progressive imagery relaxation techniques and home exercises to reduce vocal hyperfunction and promote phonatorily efficient breath-stream management. Results: Initial, 7 month, and 13 month hyperacusis measures and voice evaluations were conducted. Hyperacusis evaluations showed our participant\u27s hyperacusis for lower-frequency tones improved by up to 30 dB bilaterally and his hyperacusis for running speech improved 40 dB improved in the right ear and 35 dB in the left ear. His vocal pitch, measured as fundamental vocal frequency, improved from 404.471Hz to 280.78Hz. Conclusions: Our systematic auditory desensitization program decreased our participant\u27s hyperacusis and our modified vocal re-education therapy (VRT) program lowered his vocal pitch. However, the results did not generalize beyond the clinic. The latter may be attributable to our participant\u27s unwillingness to fully accept treatment goals, which may serve as a caveat to future clinicians to consider prognosis prior to making treatment decisions